Healthcare Provider Details

I. General information

NPI: 1821472002
Provider Name (Legal Business Name): MS. JOCELYN LOVE NAZARENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 FULLWOOD RD
MATTHEWS NC
28105-2659
US

IV. Provider business mailing address

2016 BLUE IRIS DR
MATTHEWS NC
28104-4116
US

V. Phone/Fax

Practice location:
  • Phone: 704-841-4920
  • Fax:
Mailing address:
  • Phone: 623-227-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP15675
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: